Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or seismic hinges on intra-party debates and the president’s veto.
As of noon Wednesday, Democrats had flipped seven seats in the Senate and 21 in the House, setting the party up for comfortable majorities as unexpected battleground races continue to be tallied.
Healthcare issues were a major talking point through many midterm election campaigns. In battleground Senate races, for instance, Democrats spent $65 million on ads primarily focused on healthcare, more than twice that of their next-most prominent topic. Healthcare was overall the second-most prominent issue featured in ads (as measured by spend) across the two parties, behind a push on taxation topics from Republicans.
And within those ads: promises to begin delivering lower costs, greater coverage and federal oversight, starting Jan. 1, 2027.
The immediate legislative impact will be seen in the bills new chamber leaders bring to the floor.
A health policy agenda circulated in September by a working group under Rep. Hakeen Jeffries (D-N.Y.)—the House’s current minority leader and likely speaker in the next Congress—outlined immediate, “First 100 Hours” goals that include repeal of the Medicaid coverage and funding cuts of 2025’s H.R. 1 (The One Big Beautiful Bill Act) as well as restoration of enhanced Affordable Care Act premium tax credits that expired at the top of 2026 and vastly increased marketplace plan premiums.
Other 100-hours priorities outlined in the document include medical debt protections, removal of visa program fees for healthcare workers, an end to an AI prior authorization program in Traditional Medicare, restoration of withheld National Institutes of Health funding, a block on immigration enforcement operations in hospitals and guaranteed no-cost coverage of recommended vaccines regardless of changes in federal recommendations.
Additionally, the new majorities would install key Democratic policy heads to congressional committees responsible for advancing healthcare legislation and conducting oversight into government and private sector conduct. Among those new chairs would be Vermont’s Bernie Sanders, a vocal opponent of corporate interests in healthcare and the country’s chief Medicare for All advocate, who would chair the Senate Health, Education, Labor and Pensions (HELP) Committee; and Oregon’s Ron Wyden, who as Finance Committee ranking member recently pursued oversight of Medicaid stakeholders, endorsed Sanders’ Medicare for All bill, led calls to hold “Big Insurance” accountable for administrative roadblocks to care and summarized his midterms reaction with a single word: “Subpoenas.”
Underpinning the party’s legislative leaders are a slew of new-to-office healthcare advocates. Several of those elected to Congress have backgrounds as physicians or other COVID-era public health experience. Among the standouts are Ohio Governor-elect Amy Acton, a pediatrician who was director of the state’s Department of Health and resigned early in the pandemic in protest of state leadership; and Michigan Senator-elect Abdul El-Sayed, an epidemiologist and Detroit’s former health director, who has made progressive health policy goals like Medicare for All a cornerstone of his campaign.
For the public and the healthcare industry, the key question is how Democrats will pursue their healthcare agenda under a divided government and lame-duck president.
Molly Turco, who covers healthcare policy at TD Cowen Washington Research Group, wrote in a Wednesday policy note that “with Trump in the [White House], passage of major reforms are very unlikely and even medium-sized policies, like rollbacks of Medicaid [state-directed payment] cuts or restoring ACA subsidies, are an uphill battle. But, the midterm results and catalysts like the debt ceiling give Ds leverage.”
Consultants at BRG, in a media roundtable late last week, generally agreed with the veto hurdle, but noted that a stymied Congress still has room to write and pass bills that could become new policy in a future majority, as was the case with Medicaid work requirements pushed by Republicans during the end of the Biden administration but ultimately codified last year.
There is still an avenue for dealmaking between the parties, analysts and advisors noted, such as on areas with general bipartisan agreement (think this year’s pharmacy benefit manager reforms, or other major pain points like physician pay or surprise billing arbitration reform) as part of must-pass spending packages slated for this December and the coming years. The president, for his part, told outlets late Tuesday night that he intends to work with Democrats to pass bills that he believes will benefit the country.
PricewaterhouseCoopers, in a Wednesday policy note, said “targeted bipartisan legislation is most likely to move. Look for action on cybersecurity, AI, price transparency, modernizing drug development and prior authorization processes. Regardless of congressional gridlock, continued regulatory implementation will shape near-term business and compliance requirements.”
Turco’s note predicts a dual messaging strategy for congressional Democrats of affordability and accountability, with the latter involving “an aggressive corporate investigation and hearings strategy.”
The TD Cowen analyst also questioned whether Democrats’ midterm overperformance and gains by progressive candidates will embolden the party to pursue and campaign on “bold” healthcare reforms like Medicare for All ahead of 2028.
Wyden’s recent endorsement of Sanders’ reform bill “is a powerful signal that even long-tenured moderates are under pressure to have a vision that reimagines [healthcare],” Turco wrote, though “many other D members are worried about blowback from M4A support that has almost no chance of being a viable policy. These members are vocal about their concerns and want to work on more realistic policies like restoring the ACA and Medicaid, building on IRA negotiation, reducing premiums/ deductibles for employer-based coverage, adding more benefits to Medicare, etc.”
Investment banking firm William Blair’s equity research team, in an election day brief, noted that Democratic governorships bring immediate impact to the healthcare industry as states make strategic decisions on how to implement, or offset, the provisions of H.R. 1.
The limited avenues for swiftly rolling back that sweeping bill mean industry players, including Medicare Advantage plans and margin-strapped hospitals, should begin preparing for its financial headwinds, consultants and health systems heads have said. But that doesn’t mean Democrats’ strong night has dashed all hopes for rollbacks or other tweaks to ease the pain.
“While the election has changed who controls Congress, it doesn't change the financial challenges hospitals will face in 2027,” Chris Van Gorder, president and CEO of nonprofit integrated health system Scripps Health, said in a statement reacting to midterm election results. “Democrats won't have the votes to simply reverse major federal health care cuts over a presidential veto. But Congress is far from powerless. Lawmakers can use their oversight and budget authority to press for changes in how those cuts are carried out, protect critical health care funding where possible and work across party lines to ease the growing financial pressures on hospitals and impact on patients."
Even if political gridlock takes hold, Tuesday’s results ensure that affordability will be center stage in Washington, analysts said, especially as consumers’ cost pressures will likely persist well through the 2028 election cycle.
“Even where legislation stalls, don’t dismiss the headlines,” PwC advised healthcare executives. “Democratic hearings, investigations and proposed bills offer insight into the policies taking shape for 2028, while growing pressure around affordability continues to push the healthcare market toward consumer expectations. Executives who look beyond near-term political conflict, plan for multiple policy scenarios and adapt to evolving consumer demands will be better positioned for potential healthcare reform after 2028.”
On the virtual care front, ATA Action, the advocacy-focused affiliate of the American Telemedicine Association, said the election presents an opportunity to build on strong bipartisan support for telehealth and virtual care at the federal and state levels. The group plans to continue working across party lines to make Medicare telehealth policies permanent, expand digital health access and remove regulatory barriers to virtual care, Zebley, CEO of the ATA and Executive Director of ATA Action, said in a statement.